Take Five, and Call Me

Urban legend has it that when a patron fell ill in Carnegie Hall and the call went out for a doctor in the house, half the audience stood up to help. Perhaps the concert was a medical benefit; more likely, it never happened. But there does seem to be no shortage of doctors who are musical, at least in New York, and one of them is Oliver Sacks, a neurologist and author, who has now combined two of his passions in one book.

In his earlier collections of clinical tales — most famously in “Awakenings” (1973) and “The Man Who Mistook His Wife for a Hat” (1985) — Sacks presented with compassion, sensitivity and learning what, in coarser hands, might have been freak shows of the mind. The genre could have been an exploitative sideshow: a parade of misfits whose brains have been weirdly affected by disease, trauma, congenital defect or medical treatment. But Sacks is adept at turning neurological narratives into humanly affecting stories, by showing how precariously our worlds are poised on a little biochemistry. The result is a sort of reverse-engineering of the soul.

His new collection starts quite literally with a bolt from the blue, when a 42-year-old surgeon, Tony Cicoria, was struck by lightning in 1994. Cicoria’s heart apparently stopped, but he was resuscitated, and a few weeks later he was back at work. Everything seemed normal until this fan of rock music was suddenly seized by a craving for classical piano music. He bought recordings, acquired a piano and began to teach himself to play. Then his head began to be flooded with music that seemed to come, unstoppably, from nowhere. Within three months of his electrocution, Cicoria had little time for anything other than playing and composing.

A dozen years later, Cicoria is still an extreme musicophiliac but has no desire to investigate his own condition with the finer-tuned forms of brain scanning that are now available. He has come to see his condition as a “lucky strike.” The music in his head is, he says, “a blessing ... not to be questioned.” (He was certainly lucky not to be killed. Standing in thunderstorms cannot yet be recommended as a new answer to the old question of how to get to Carnegie Hall.)

Thanks to the willingness of others to be scanned, though, we now know that musicians’ brains are different. The corpus callosum, which connects the brain’s two hemispheres, is bigger in professional musicians. And people with absolute pitch (that is, those who can immediately name a heard note) have an asymmetric enlargement in a part of the auditory cortex. Because of this, and because of other distinctive differences in the distribution of gray matter, Sacks says that anatomists now have no difficulty in spotting the brain of a professional musician. (They cannot yet do this for the brain of a writer or visual artist.) It is not clear to what extent such marks of a musical brain are innate and to what extent they are the result of musical training and practice. But according to Sacks, these markers are strongly correlated with the age at which musical training begins and with the intensity of practice.

Even with no training or practice, some unusual patients embrace music with an enthusiasm almost as intense as Cicoria’s. These are people with Williams syndrome, whom Sacks calls a “hypermusical species.” The syndrome is caused by a rare genetic defect that produces a strange mixture of strengths (sociability, liveliness, large vocabularies and a fondness for telling stories) and weaknesses (most have I.Q.’s under 60). They also have heart defects and distinctive faces, with wide mouths, small chins and upturned noses. All, it seems, are extremely responsive to music from an early age. Some have striking gifts of musical memory, though not all are musically talented.

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If music gives these individuals a joy that helps to compensate for their other disadvantages, it is little short of a lifeline for Clive Wearing. Wearing is an English musicologist and musician who contracted a severe brain infection and was left with a memory span of just a few seconds. His case is the most distressing in Sacks’s collection and was featured in a BBC documentary aptly titled “Prisoner of Consciousness.” With no past, not even one from a minute ago, Wearing does not really occupy a present either. “It’s like being dead,” he once told his wife. Although he does not remember her, he is always overjoyed to see her, continually meeting her for the first time. It is similar with his music. Asked to play a Bach prelude, he says he has never played any of them before; but then he plays one and says, while playing, that he remembers this one. In an intriguing and paradoxical conjecture, Sacks suggests that “remembering music is not, in the usual sense, remembering at all. ... Listening to it, or playing it, is entirely in the present.”

Music has been used successfully as a treatment for many kinds of mental suffering. Indeed the benefits of the singing cure are more evident than those of the talking one. The first formal programs of music therapy began in the 1940s, and it is now used successfully to ameliorate the symptoms of motor and speech disorders, aphasia and several forms of dementia. Sacks describes as astonishing the sight of deeply demented patients waking from their torpor or casting aside their agitation to focus on songs that are played to them. He also recounts an extreme case of Tourette’s syndrome in another English musician, who was racked by nearly 40,000 compulsive tics per day. The man’s life was transformed when his family got a piano. He now finds relief only when performing.

Yet in rare cases, music can become a torture rather than a balm. At the end of his life, Schumann was tormented by musical hallucinations that degenerated into a single incessant note. Sacks describes a child who has been plagued by continuous involuntary music in the head from the age of 7. Such people must sometimes wish they were as unmusical as Ulysses S. Grant, who apparently claimed to know just two tunes: “One is Yankee Doodle and the other is not.” Freud, despite being both Viennese and a medical man, said he was almost incapable of obtaining any pleasure from music: “Some rationalistic, or perhaps analytic, turn of mind in me rebels against being moved by a thing without knowing why I am thus affected and what it is that affects me.”

In the end, Sacks’s catalog of oddities sheds little systematic light on the mystery of music. He cannot be blamed for this — the science of music is still in its early days. Readers will probably be grateful that Sacks, unlike Freud, is happy to revel in phenomena that he cannot yet explain.

MUSICOPHILIA

Tales of Music and the Brain.

By Oliver Sacks.

381 pp. Alfred A. Knopf. $26.

Anthony Gottlieb podcasts for The Economist and teaches the history of ideas at the CUNY Graduate Center. He is writing a book about nothingness.

A version of this review appears in print on , on Page 716 of the New York edition with the headline: Take Five, And Call Me. Today's Paper|Subscribe